Novel therapies curb surgery for ulcerative colitis, study suggests
Greater access to innovative treatments could be linked to a drop in patients requiring surgery for a type of inflammatory bowel disease, a 20-year study suggests.
The number of patients using so-called advanced therapies – medicines designed to target a specific part of the immune system – to tackle ulcerative colitis rose rapidly between 2004 and 2023, accompanied by a dramatic drop in surgical interventions.
The recent expansion in new therapies provides patients with a more personalised approach to treatment and long-term management of their condition, experts say.
More than 300,000 people in the UK live with ulcerative colitis, a long-term condition where the colon and rectum become inflamed.
When drugs fail to control the inflammation, patients can undergo a colectomy to remove the large intestine, a major life-changing procedure resulting in the use of stoma bags to collect stools.
Breakthroughs in novel therapies have led to a substantial increase in the number of medicines to treat ulcerative colitis in recent years. These advanced therapies target the immune system to help control inflammation, better managing progression of the condition and reducing the need for surgery.
Researchers at the University of Edinburgh examined prescribing and colectomy trends across two decades, from 2004 to 2023, for the Lothian IBD Registry – a database including nearly all ulcerative colitis patients treated by the NHS Lothian Health board.
The number of patients living with the condition more than doubled in the Lothian region between 2004 and 2023, rising from two in 1000 people to four in 1000 people. 4115 patients with ulcerative colitis were recorded in 2023.
A total of 720 patients were prescribed an advanced therapy over the study period. This increased from zero patients in 2004 to 115 patients in 2023.
Researchers identified 563 patients who had a colectomy over the same time period, with the number of patients receiving surgery dropping from 42 in 2004 to only seven in 2023.
Statistical analysis of the findings suggests 2013 was a key turning point, when the prescribing of advanced therapies significantly increased and the rates of colectomy began to decline simultaneously.
The study also uncovered recent trends in the use of different advanced therapies.
The most used first-line therapy since 2021 has been a drug called filgotinib, which can be given orally. Some advanced therapies must be given by infusions or injections, increasing costs. The use of an oral drug could help to save money and resources in an already stretched healthcare system.
While there is a clear correlation between the uptake of advanced therapies and decreased colectomy rates over time, the findings cannot prove that the decrease in surgery is caused by access to new treatments, researchers say.
The study focused on the Lothian region in Scotland, which has ready access to advanced therapies. Study leaders say larger studies are needed, including across regions with reduced access to advanced therapies, to better understand the broader impact of recent treatments on colectomies.
The study, funded by UK Research and Innovation, is published in the journal Alimentary Pharmacology & Therapeutics. The research team included scientists from the University of Edinburgh and NHS Lothian.
Professor Charlie Lees, study lead from the University of Edinburgh’s Institute of Genetics and Cancer, said: “Our real-world data in Edinburgh show that as soon as we began prescribing targeted biologic and small-molecule drugs at scale, the need for colectomy plummeted-falling by more than 80 per cent since 2004. Ensuring that everyone with ulcerative colitis has timely access to these advanced therapies could spare many more people from life-changing surgery and the physical and psychological burden that follows.”
Dr Tracey Gillies, Medical Director of NHS Lothian, said: “We’re proud of our IBD service in NHS Lothian and the standards of care it provides. Over the years, we have invested in staff and developed services to make them more accessible and ensure patients can benefit from advanced therapies and clinical trials.
“Our leading role in academic studies such as this, helps us to continually evolve and feature in a number of reports as an exemplar.”
Reference:
Alexander T. Elford, Nathan Constantine-Cooke, Phil W. Jenkinson, Beatriz Gros, Nikolas Plevris, Twenty-Year Trends in Colectomy Rates and Advanced Therapy Prescribing in Lothian, Scotland, Alimentary Pharmacology & Therapeutics, https://doi.org/10.1111/apt.70240
